Journal of evaluation in clinical practice
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Hearing loss is a common problem for older adults entering rehabilitation hospitals. ⋯ Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour.
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Increasing demand for hospital services can lead to overcrowding and delays in treatment, poorer outcomes and a high cost-burden. The medical ambulatory care service (MACS) provides out of hospital patient care, including diagnostic and therapeutic interventions for patients that require urgent attention, but which can be safely administered in the ambulatory environment. The programme is yet to be rigorously evaluated. ⋯ MACS was found to be cost-effective for GP and ward-referred groups, but the expected impact for ED-referred patients is sensitive to assumptions. Expansion of the service for GP-referred patients is expected to reduce hospitalizations the most and generate the largest net cost savings.
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Patients who seek healthcare for long-lasting pain and symptoms without a detectable disease must put in extra work to be taken seriously and gain recognition as a patient. However, little is known about how patients' help-seeking is performed in clinical practice. The aim of the current study was to gain knowledge about the ways in which patients with chronic muscle pain position themselves as help-seekers during their first physiotherapy encounter. ⋯ Patients with chronic muscle pain seek to establish their legitimacy through the positivistic discourse of medicine and also through their compliance with the moral discourse of the patient as someone active, willing to take responsibility for their own health-and therefore worthy of treatment.
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After-hours documentation burden among US clinicians is often uncompensated work and has been associated with burnout, leading health systems to identify root causes and seek interventions to reduce this. A few studies have suggested quality programme participation (e.g., Merit-Based Incentive Payment System [MIPS]) was associated with a higher administrative burden. However, the association between MIPS participation and after-hours documentation has not been fully explored. Thus, this study aims to assess whether participation in the MIPS programme was independently associated with after-hours documentation burden. ⋯ MIPS participation may increase after-hours documentation burden among US office-based physicians, suggesting that physicians may require additional resources to more efficiently report data.
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Effective preoperative assessments of determinants of health status and function may improve postoperative outcomes. ⋯ Using easily accessible preoperative patient factors, including PROMs, we developed models which may help predict dissatisfaction and lack of improvement following hip and knee replacements and facilitate risk stratification and decision-making processes.